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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Resection of the ascending aorta with or without aortic valve replacement requires prolonged interruption of myocardial blood flow. Profound local cardiac hypothermia was used in 8 patients, 5 of whom had simultaneous aortic valve replacement. Three patients with acute dissections were encountered, one with cardiac tamponade secondary to intrapericardial rupture. The duration of aortic cross-clamp time varied from 43 to 122 minutes. There were no complications related to the cooling technique. There were no operative or hospital deaths. One patient died of myocardial infarction at 6 weeks. These results coupled with the experience of others suggest that coronary perfusion during periods of obligatory anoxia in unnecessary. Local cardiac hypothermia offers a satisfactory alternative for myocardial protection during prolonged aortic crossclamping.
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PMID:Resection of the ascending aorta using profound local hypothermia for myocardial protection. 113 Aug 88

Extracorporeal circulation can be utilized successfully to rewarm accidental hypothermia victims. This paper describes a 51 year-old man who had been immersed in cold sea water for about 45 minutes. At the time of rescue his ECG was isoelectric. The core temperature was 27 degrees C. Cardiopulmonary resuscitation was performed for 190 minutes before extracorporeal circulation was established. Without active surface rewarming the temperature had dropped to 24 degrees C. Biventricular heart failure became evident during rewarming. Sternotomy and pericardiotomy were carried out to exclude cardiac tamponade, which was not found. After two hours of reperfusion the patient could be weaned from bypass supported by high-dose vasopressor infusion. He was extubated the following day. He was discharged after 12 days without any signs of permanent damage to organs.
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PMID:[Deep accidental hypothermia with asystole. A successful treatment with heart-lung machine after prolonged cardiopulmonary resuscitation]. 199 75

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

From January 1989 to September 1993, 59 consecutive patients (35 males and 24 females, mean age 59.6 years old) underwent surgical repair of aortic dissection on the cardiovascular surgical unit at Takeda Hospital. The type of aortic dissection were classified according to Stanford University criteria. Twenty-two patients had acute type A (Ac-A), 10 had chronic type A (Ch-A), 4 had acute type B (Ac-B), and 23 had chronic type B (Ch-B) dissection. Seventeen dissections (29%) in the entire group of 59 cases had ruptured (including cardiac tamponade, pleural effusion and hemoptysis etc.). Ischemia of lower extremity occurred in 7 patients and ischemia of visceral organs in 3 patients. Type A dissection were approached via a median sternotomy and cardiopulmonary bypass with systemic hypothermia. Type B dissections were approached through a left postrolateral thoracotomy. Left heart bypass (left atrial-femoral in 8 cases) and partial cardiopulmonary bypass (femoral-femoral in 12 cases) generally were utilized. Resection of intimal tear and replacement of aorta with vascular grafts (including aortic arch in 19 cases) were performed in most patients and primary closure of the intimal tear was performed in 9 cases using GRF. The over-all operative mortality rate was 36% (8/22) for Ac-A, 20% (2/10) for Ch-A, 25% (1/4) for Ac-B, 22% (5/23) for Ch-B. Main causes of operative death was perioperative brain damage. It is necessary to improve the operative mortality for Ac-A dissections (especially in replacement of aortic arch and arch vessels). Further researches are needed regarding optimal methods of the cerebral protection during reconstruction of aortic arch.
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PMID:[Results of surgical treatment of aortic dissections]. 788 69

Deep hypothermic circulatory arrest (DHCA) was introduced as an adjunct for operations involving aortic arch lesions in 1970's and has since been widely used. Profound hypothermia protects the brain and other vital organs by reducing metabolic rate. We initiated the use of continuous retrograde cerebral perfusion (CRCP) via the superior vena cava during DHCA in 1987. We studied 15 patients who required DHCA and CRCP during repair or replacement of the aortic arch. CRCP times ranged from 11 to 78 (mean +/- S.D.; 37.3 +/- 21) minutes, and minimal nasopharyngeal temperatures ranged from 13.7 to 25 (17.7 +/- 2.6) degrees C. Two patients died one month postoperatively due to preoperative disease. Three patients, who were in shock preoperatively due to cardiac tamponade, developed acute renal failure postoperatively. The remaining patients were weaned from the respirator by the 2nd postoperative day. No patient had CRCP-related complications. During CRCP, the partial pressure of oxygen (PO2), saturation of oxygen (SO2), and oxygen content significantly decreased (p < 0.001), and the partial pressure of carbon dioxide (PCO2) and CO2 content significantly increased (p < 0.001) between retrogradely perfused blood and blood draining from the arch vessels. These results most probably reflected that the aerobic metabolism of the brain was maintained by CRCP while the central nervous system was maintained in a hypothermic state, with oxygen and substrate availability, wash-out of metabolites, and buffering capacity and oncotic pressure of the blood maintained. This technique offers the potentials of sufficient metabolic support to the brain during DHCA and prolonged safe time limits of DHCA.
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PMID:[The protective effect of continuous retrograde cerebral perfusion on the central nervous system during deep hypothermic systemic circulatory arrest]. 851 53

Between May 1993 and August 1994, 15 patients (10 men) with type A aortic dissection (9 acute) had a replacement of the ascending aorta and/or aortic arch with circulatory arrest with profound hypothermia and retrograde cerebral perfusion. Mean circulatory arrest time was 47.5 min (range 23 to 68 min). Three patients (20%) died in relation to postoperative bleeding. No patient had a new neurologic damage related to surgery. Ten patients were awake and oriented before 24 hours of the operation and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were operated on with a recent stroke. One of them recovered without sequelae before hospital discharge and the other one had a major regression of his brain damage. Two other patients had emergency surgery because of cardiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed dialysis. There was no case of Q wave infarction nor congestive heart failure in the perioperative period. Follow-up was 100% completed (12 patients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious process. Eight patients are in functional class I and 3 in II. Ten of them are back to their usual activities'. Although retrograde cerebral perfusion is a new surgical technique, it seems to be a very valuable complement for brain protection in ascending aorta and/or aortic arch surgery with circulatory arrest with profound hypothermia.
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PMID:[Retrograde cerebral perfusion during circulatory arrest with deep hypothermia. A new technique for brain protection in surgery of ascending aorta and aortic arch]. 873 66

The ruptured thoracic aortic aneurysm is still a dramatic even with very poor outcome, whereby its survival depends largely on early diagnosis and operation. We report a successful case of aortic arch replacement for ruptured aortic arch aneurysm with cardiac tamponade. Lethal hemopericardium causing cardiac tamponade is most commonly seen as a complication of acute myocardial infarction or acute aortic dissection, and subsequent rupture of the heart or ascending aorta leads to the rapid accumulation of blood within the poorly distensible pericardial sac. Our case was operated upon emergency basis due to hemopericardium. On operative findings, the aortic aneurysm located the minor curvature of aortic arch and was a huge saccular shape. In surgical procedure, the total arch replacement was completed using selective cerebral antegrade perfusion with deep hypothermia. Postoperative course was uneventful and no cerebral complication was observed after surgery.
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PMID:[A case of ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade]. 921 85

A retrospective study was conducted for the surgical treatment on acute aortic dissection among the cardiovascular services of 5 affiliated hospital of medical school. The total of 74 cases were operated for the last 5 years period from Jan., 1991 to Dec., 1995, in which 64 cases were classified as Type A and 10 for Type B. The average age for Type A was 58.4 years old and 10% of patients were consisted of Marfan syndrome. The most frequent complications associated with dissection was aortic regurgitation (37.5%), followed by cardiac tamponade (23.4%). The surgeries were undertaken in less than 24 hours from the onset of symptom in 45.3% of patients. The localization of initial tear as was proved by intraoperative finding was at ascending aorta in 64.0%, whereas it was found at aortic arch in 21.8% of patients. The most frequent application of operative procedure was simultaneous graft replacement of ascending aorta and aortic arch (68.7%) with the use of profound hypothermia and antegrade selective cerebral perfusion (85.4%). The overall mortality rate was 25.0%, however when compared as ascending only vs ascending + arch replacement, the later group demonstrated higher mortality rate (16.6% vs 28.9%). The majority of surgical indication for Type B was hemorrhage from the dissection and 20.0% of mortality was recorded in this group of patients.
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PMID:[The surgical treatment for acute aortic dissection--a retrospective study from the statistics of affiliated hospitals of a medical school]. 958 77

During 1994-1996 at the Clinic of Cardiovascular and Transplantation Surgery of IKEM 17 patients were operated with acute dissection of the thoracic aorta type A. Based on the applied surgical tactics the patients were retrospectively divided into two groups. The first included 8 patients where surgical reconstruction of the ascending aorta was implemented in the standard way, the second group comprised 9 patients where the method of deep hypothermia and circulatory arrest were used. Three operated patients died, all from the group with deep hypothermia. The cause of death was twice multiorgan failure and once haemorrhage in a female patient with cardiac tamponade before surgery. The authors discuss the advantages and some pitfalls of surgery in deep hypothermia and circulatory arrest and maintain that neurological disorders are most serious. In the conclusion they draw attention to some possible ways how to improve hitherto achieved results. They include e.g. reduction of the time interval between the development of symptoms of dissection and surgery, careful checking of the cooling and heating when using deep hypothermia, as well as better prevention of cerebral embolic attacks.
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PMID:[Various technics in the surgical treatment of dissection of the thoracic aorta]. 965 59

The ruptured thoracic aortic aneurysm has had severely high mortality. A 71-year-old male who suddenly fainted away was admitted to our hospital. He was in shock on arrival. Computed tomography and echo cardiogram demonstrated ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade. Aortic arch replacement was performed using the selective cerebral perfusion under deep hypothermia. The recovery of his consciousness was delayed, and he had right hemiplegia postoperatively, but his state was improved gradually. Finally he complained only slight degree of aphasia, paralysis. An immediate and aggressive emergency operation is a only method to salvage the patient who has ruptured aneurysm of the thoracic aorta.
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PMID:[Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report a case]. 983 83


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